The authors comment enzyme inhibitor that nausea, vomiting, and sialorrhea generally improved after modificating their technique to a double plication. Two patients presented with upper GI bleeding a few weeks after discharge. They were treated with endoscopic hemostasis. Two patients returning with general abdominal discomfort were found to have microleaks which were treated conservatively. Four patients had to be reoperated. One patient presented with portomesenteric thrombosis an the 24th postoperative day. The authors comment that portomesenteric thrombosis is a rare but serious complication of all laparoscopic operations, probably attributed to venous stasis due to pneumoperitoneum and anti-Trendelenburgs position [17]. The patient had jejunal necrosis and underwent jejunectomy.

1 patient was reoperated for gastric obstruction due to prolapse of the gastric fold, while two had accumulation of serous fluid within the cavity of the plication. These final cases led to the modification of their technique with creation of a double plication, thus creating smaller multiple gastric folds with less probability of both prolapse and accumulation of fluid. Mortality was zero. This is a very interesting study, the largest in literature so far, with relatively good medium term followup. The results on %EWL are similar to those achieved with LSG. Major complication rate is quite low (2.9%) and resulted in no mortality. The authors have presented a new modification to the standard technique of LGCP which could bear many benefits.

Unfortunately they appear to be using the new technique in all new cases, instead of randomizing them in two groups of single-fold and multiple-fold technique. In any case, results presented in this study are very good with %EWL rates similar to those achieved with LSG for the 24 month follow-up period and low complication rates. Long-term follow-up results should be interesting. Andraos et al. published a series of 120 cases [10]. Mean operative time was 65 minutes (45�C90 minutes) and mean hospital stay was 36 hours (24 to 120). Most patients were discharged in 24 hours. There was one conversion due to intraoperative bleeding. Followup is very short, of only six months. Mean TWL in 1, 3 and 6 months is reported at 11.2kg, 16kg, and 23kg, respectively, whereas %EWL at the same time is reported at 30.2% at 1 month, 43.9% at 3 months, and 48.58% at 6 months. No Batimastat conclusions can be drawn on the effectiveness of LGCP from this study so far. Medium- and long-term follow-up results should prove useful. What makes this publication interesting is the very detailed description of complications.